Malawi’s preparations to develop an integrated HIV/TB concept note required under the new funding model have included the election on 12 February of two new members to its country coordination mechanism (CCM) with roots in the TB community.
Malawi had an estimated incidence of co-infection of 16,000 cases in 2012, representing 59% of the number of people in the country living with HIV. Roughly 70% of AIDS-related deaths in the southern African country are attributed to latent TB.
Some $11.2 million in Global Fund grants have been allocated to Malawi’s TB program since January 2009, aiming to pursue DOTS expansion and enhancement, infection control, activities to manage multi drug-resistant TB (MDR-TB) and co-infection with HIV. Thus far 25,000 people have been placed on first-line treatment, which has helped to reduce treatment regimens from 18 to six months.
There remain significant hurdles for the country to bring its TB infections under control, said new CCM member Hastings Banda of Research for Equity and Community Health (REACH Trust).
TB detection rates in Malawi remain low because of a lack of screening and availability of services nationwide, he said, including a lack of reagents to conduct testing at the health facility level.
Low levels of treatment literacy among TB patients means a low level of adherence to drug regimens, which promotes resistance and the spread of MDR-TB. Among detainees in the prison system, TB infection is especially high because of a lack of consistent screening on intake and routinely during an inmate’s incarceration.
Stigmatization of TB also means that those who are infected are reluctant to seek treatment, Banda said.
Mara Kum’bweza Banda, the chairperson of the National AIDS Commission, says that she hopes that her election to the CCM as a person living both with HIV and TB will help orient the CCM towards the promotion of an integrated approach to the two diseases, while also helping her serve as a role model for other people suffering in silence.
“I would like to encourage people infected with TB to come out and seek treatment as I believe this is the only way that we can fight stigma and build a united front to fight the disease,” she said.
Owen Nyaka is a Key Correspondent for the International HIV/AIDS Alliance.